Abstract
BackgroundConsent to episiotomy is subject to the same legal and professional requirements as consent to other interventions, yet is often neglected. This study explores how women experience and perceive the consent process.MethodsQualitative research in a large urban teaching hospital in London. Fifteen women who had recently undergone episiotomy were interviewed using a semi-structured interview guide and data was analysed using thematic analysis.ResultsThree themes captured women’s experiences of the episiotomy consent process: 1) Missing information – “We knew what it was, so they didn’t give us details,” 2) Lived experience of contemporaneous, competing events – “There’s no time to think about it,” and 3) Compromised volitional consent – “You have no other option.” Minimal information on episiotomy was shared with participants, particularly concerning risks and alternatives. Practical realities such as time pressure, women’s physical exhaustion and their focus on the baby’s safe delivery, constrained consent discussions. Participants consequently inferred that there was no choice but episiotomy; whilst some women were still happy to agree, others perceived the choice to be illusory and disempowering, and subsequently experienced episiotomy as a distressing event.ConclusionsConsent to episiotomy is not consistently informed and voluntary and more often takes the form of compliance. Information must be provided to women in a more timely fashion in order to fulfil legal requirements, and to facilitate a sense of genuine choice.
Highlights
Consent to episiotomy is subject to the same legal and professional requirements as consent to other interventions, yet is often neglected
A World Health Organisation (WHO) recommendation on episiotomy policy suggests that this oversight may extend to episiotomy consent practice: women reported being poorly informed about the procedure and its short- and Djanogly et al BMC Pregnancy and Childbirth (2022) 22:139 long-term consequences, and were rarely asked for their consent [9]
The WHO’s global drive for positive birth experiences through woman-centred care and the provision of genuine choice [10] necessitates a clearer understanding of how consent for episiotomy is gained and how women perceive this process
Summary
Consent to episiotomy is subject to the same legal and professional requirements as consent to other interventions, yet is often neglected. The WHO’s global drive for positive birth experiences through woman-centred care and the provision of genuine choice [10] necessitates a clearer understanding of how consent for episiotomy is gained and how women perceive this process. Despite these reported difficulties, a dearth of resources exists advising clinicians on how to obtain consent for the procedure [11]. Montgomery’s patient-centred test of information disclosure suggests that adequate consent is to some extent defined by the patient – and further, that lawful episiotomy consent practice hinges on an understanding of the values, concerns, and expectations of women who face the procedure
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